Arterial Occlusive Diseases

The mainstay of treatment for long-segment small-vessel chronic occlusive disease not amenable to endovascular intervention remains surgical bypass grafting using autologous vein. The procedure is largely successful and the immediate operative results almost always favorable. However, the lifespan of a given vein graft is highly variable, and less than 50% will remain primarily patent after 5 years.

Basilar artery occlusion developed in a 34 year old woman 2 months after adopting unusual neck postures during yoga practice. On angiography, her basilar artery was filled with intraluminal clot while the vertebral arteries were normal. We postulate that a severe reduction in blood flow and possibly an intimal tear triggered thrombosis of the vertebral artery and that the final stroke mechanism was artery-to-artery embolism.

The incidence of lymphodemas after vascular surgical reconstructions is underestimated. In stage III and IV of PAOD 80% of our patients are suffering from lymphodemas, in stage II about 30%. In stage III and IV a postreconstructive edema occurs more often, in stage II the incidence of both, secondary lymphedema and postreconstructive edema is similar. A complex physical therapy (CPT) after a successful surgical reconstruction decreases the swelling of the legs by special lymphatic massage and the patients are earlier rehabilitated.

To help in determining management strategy as an alternative to amputation by using a synthetic prostacycline, a preliminary study was undertaken in 12 patients (11 men and one woman), with a mean age of 71.08 years, ie, 13 limbs evaluated at the stage of amputation. All patients were treated with a combination of iloprost and physical therapy (massage, specific exercises, cardiorespiratory training). Static transcutaneous oxygen pressure (TcPO2) was measured, with a sensitization test by verticalization and inhalation of oxygen, on day (D) D0, D15, D28, D60, D180, and D365.

We report a case of ophthalmic artery obstruction combined with brain infarction following periocular autologous fat injection. The patient, a 44-year-old woman, visited our hospital for decreased visual acuity in her left eye and dysarthria one hour after receiving an autologous fat injection in the periocular area. Her best corrected visual acuity for the concerned eye was no light perception. Also, a relative afferent pupillary defect was detected in this eye. The left fundus exhibited widespread retinal whitening with visible emboli in several retinal arterioles.

OBJECTIVE: The purpose of this study was to determine whether a 6-month exercise rehabilitation program can improve cardiovascular risk factors in patients with peripheral arterial occlusive disease (PAOD). METHODS: Thirty-four patients (mean age, 68 +/- 8 years; range 54-84 years) with PAOD with intermittent claudication (Fontaine stage II) and 14 longitudinal controls of comparable age with stage II PAOD enrolled in an exercise intervention at the University Medical Center and Veterans Affairs Medical Center at Baltimore, Maryland.

Five cases of occlusion of the vertebral artery in context with mechanical stress - from endogene reasons in one case - and lesions of the vessel walls (in three cases) are recorded. The inferior posterior cerebellar artery was involved in all cases. Variable ischemic lesions resulted in the medulla oblongata and in the cerebellum, which were survived up to four weeks in one case. In the others death occurred within few hours or suddenly and unexpectedly. Related neurological symptoms were absent in one case only.

Nystagmus together with the history, X-ray and palpation findings were used to confirm the diagnosis of the cervical spine syndrome. In patients with this disorder the nystagmus was controlled by manual treatment in 63%. Nystagmus therefore can be used objectively to assess the success of therapy in cervical spine syndrome.